Medicare and Medicaid

Jennifer Mathieu, senior vice president of professional and government affairs at the Academy of Managed Care Pharmacy
By  Jessica Hagen 12:37 pm September 22, 2023
The Access to Prescription Digital Therapeutics Act, initially introduced in the U.S. Senate in 2022 and reintroduced in March of this year, aims to amend the Social Security Act to provide Medicare and Medicaid coverage and reimbursement for prescription digital therapeutics.  Jennifer Mathieu, senior vice president of professional and government affairs at the Academy of Managed Care Pharmacy (...
A person talking to a provider via a video call.
By  Emily Olsen 12:11 pm May 8, 2023
During the first year of the COVID-19 public health emergency, Medicare improperly paid for $580 million of psychotherapy care, including $348 million of telehealth services, according to an audit by the Department of Health and Human Services' Office of the Inspector General. The report, which estimated that Medicare paid for $1 billion of psychotherapy that year, included more than 13.5 million...
An older person talking to a provider through a video chat on a tablet.
By  Amar Kendale 10:16 am April 14, 2023
We’re witnessing massive demographic and market shifts that will accelerate the race to value-based healthcare. Case in point: The Medicare Payment Advisory Commission (MedPAC) predicts that Medicare Advantage enrollment will soon eclipse traditional Medicare for the first time. With more people becoming eligible for Medicare than ever before, our healthcare system is experiencing the broad shift...
A person getting a vaccine at a pharmacy.
By  Emily Olsen 10:27 am March 24, 2023
Last month, two large retail and pharmacy companies made big moves in healthcare delivery: Amazon completed its purchase of One Medical, and CVS Health announced plans to buy Oak Street Health.  The deals aren't unexpected, said Christopher Lis, managing director of global healthcare intelligence at J.D. Power. More than 31 million people are now enrolled in Medicare Advantage plans, key...
A doctor talking to a patient while holding a tablet.
By  Emily Olsen 12:57 pm March 10, 2023
The healthcare status quo for Medicaid and other underserved patients frequently leaves them in the lurch, said Cityblock Health CEO and cofounder Dr. Toyin Ajayi. They may have infrequent access to the medical system, hampered by transportation issues or the need to take time off work. Doctors' offices can be busy, and they may not have enough time to address concerns. Meanwhile, racial and...
A provider listening to a patient's heartbeat in their home.
By  Emily Olsen 02:45 pm February 24, 2023
Blue Cross and Blue Shield of Minnesota announced it had entered into a full-risk value-based care arrangement with hybrid startup Homeward that aims to increase access for rural Minnesotans.  The insurer and the rural healthcare startup said Medicare Advantage members in 24 Minnesota counties outside of the Twin Cities metropolitan area will be able to use Homeward's services. The company offers...
A gavel lying on a pile of hundred dollar bills.
By  Emily Olsen 11:17 am February 10, 2023
Online birth control pharmacy The Pill Club reached an $18.3 million settlement with California authorities for allegedly defrauding the state's Medicaid program. According to the California Department of Justice, the company billed Medi-Cal for services it hadn't provided, allegedly submitting claims for 30-minute face-to-face counseling sessions when its nurse practitioners didn't have direct...
A masked person walking by a CVS pharmacy.
By  Emily Olsen 11:46 am February 8, 2023
After weeks of rumors, CVS Health announced plans to acquire Oak Street Health, a primary care provider geared toward the Medicare population, in a deal worth approximately $10.6 billion. Chicago-based Oak Street Health runs 169 clinics in 21 states, employing about 600 primary care providers. CEO Mike Pykosz will continue to head up the company following the deal's close, which the companies...
Businesspeople shaking hands.
By  Emily Olsen 12:35 pm February 7, 2023
CVS Health is reportedly getting close to an agreement to acquire Oak Street Health, a primary care provider geared toward the Medicare population, for about $10.5 billion including debt. According to reporting by the Wall Street Journal that cites sources familiar with the deal, the companies are considering a price of about $39 per share. The acquisition could be announced this week, pushing...
A doctor using a tablet in a patient exam room
By  Emily Olsen 11:14 am January 26, 2023
Pearl Health, which offers a technology platform for primary care practices in value-based care arrangements, announced Thursday it had raised $55 million in Series B funding. The company said it also anticipates receiving a $20 million line of credit outside of the equity raise. The round was led by Andreessen Horowitz and Viking Global Investors, with participation from investors including...